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Vol. 23, No. 9, SEPTEMBER 2006


President's Note:
Powered by Insight
Cycling to True Collaboration


By Mary Fran Tracy, RN, PhD, CCNS, CCRN, FAAN
President, AACN

Have you ever found yourself taking care of patients when, based on their acuity and number, things should have been quiet and calm? Instead, chaos reigned and nothing seemed to flow. Conversely, have you ever experienced the exhilaration when your unit received multiple unscheduled admissions complicated by unplanned procedures and tests? Yet everything fell into place. Things ran like clockwork. The interdisciplinary team noticed even the most subtle condition changes and worked together to prevent a devastating complication.

We are different so that we can know our need of one another, for no one is ultimately self-sufficient. A completely self-sufficient person would be subhuman.
—Archbishop Desmond Tutu

At first I found Archbishop Tutu’s words needlessly harsh. Knowing him to be a man of great wisdom, and respecting our commitment to gaining and sharing our insights, I searched further, recalling that this quote appeared in the AACN Standards for Establishing and Sustaining Healthy Work Environments. My attention immediately focused on AACN’s commitment to true collaboration as a key element of healthy work environments.

“Nurses must be relentless in pursuing and fostering true collaboration,” the standard requires. I’ve been thinking about this lately, wanting to gain insight. Examining occupations different from our own is one way of gaining insight, so I looked at one far removed from nursing.

On the surface, stage cycling, the kind done in the Tour de France, appears to be an individual sport. Lance Armstrong, the well-known, seven-time Tour winner and cancer survivor, thinks otherwise. He contends that cycling is, in fact, a team sport with every winner highly dependent on the team—fellow riders, mechanics, team manager, cooks, health professionals—to win a race. While the world only saw Lance as the winner, he wrote his book, Every Second Counts, to tell his team’s story.

The Tour de France is actually a race made up of many smaller races—also called stages or phases—with different stages emphasizing different skills. Time trials allow sprint cyclists to excel. Another stage is geared to those skilled in cycling to a mountain summit. Team members have specific roles. One chases down a breakaway group of cyclists. Another brings food and supplies to the team leaders. In successful cycling, teamwork demands that team interest be placed above self-interest; with a well-crafted strategy in place, individual skills are used to benefit the entire team. Those who excel in one stage know that on another day, in another race, it will be a fellow teammate’s chance to lead and excel.

Doesn’t this seem to parallel our experience with patient care? Assuring palliative care and family presence allows nurses to excel. Likewise, pharmacists stand out by handling complex pharmacologic regimens. Physicians do so when unraveling confounding diagnostic scenarios. And social workers shine by untangling reimbursement challenges and supporting complicated discharge planning.

True collaboration is more than coordination and cooperation. It derails any attempts at self-sufficiency by incorporating the very same preconditions as stage cycling. It demonstrates shared objectives and different skill sets, coupled with heartfelt commitment. Teamwork may not always be an element of coordination and cooperation, but without it, true collaboration cannot exist. When collaboration is the norm, team members accept responsibility for their roles while valuing and respecting one another’s expertise. As different roles gain prominence when patient and family needs change, team members remember that each role is vital. The result: outcomes that are not humanly possible when each individual works alone.

It’s easy for team members to isolate themselves in chaotic acute and critical care environments. But focusing on individual tasks, plans and agendas fosters aloneness and isolates others who are there to support. Skilled communication and mutual trust are needed to develop a collaborative team willing to look beyond the needs of the individual and address the needs of patients and their families. What does true collaboration mean for your work team? Here’s a place to start: Examine with your colleagues why some uncomplicated work shifts seem chaotic, while very complex ones may glide by effortlessly. You may find breakthrough “ahas!” that will transform your work environment. (And remember to share those with me at Ambigrams are words that can be read two ways. What do you see in this popular ambigram by artist John Langdon? Do you see me? Or do you see you? Visit www.johnlangdon.net to experience more playful, visual insights..)

I can embrace true collaboration as the expectation for my work environment. I can have honest conversations with everyone on my team—from physicians and social workers to pharmacists and housekeepers—sharing my insights about the effectiveness of our collaboration and what developmental and team-building opportunities we may need to achieve what is optimal.

“Teamwork is not only performance-enhancing, it’s comforting,” Armstrong says. “You are never alone and, whether you have a 6-mile climb up an alp with a cadre of attackers behind you or a round of chemo in front of you, that’s extremely reassuring. The fact is, no one ascends alone.”

Ultimately, when true collaboration becomes our standard, we are at our most human with both patients and team as winners. Now that’s really something to celebrate, don’t you think?


What Do You See?

See something a new way and you’ll never see it the old way again. Each of my columns this year will feature a different graphic so we can share a different dimension of seeking insights.—MFT

Ambigrams are words that can be read two ways. What do you see in this popular ambigram by artist John Langdon? Do you see me? Or do you see you? Visit www.johnlangdon.net to experience more playful, visual insights.